Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

SUMARDI, KUSUMO

NPI: 1811037435 · LA VERNE, CA 91750 · General Practice Dentistry · NPI assigned 02/06/2007

$58K
Total Medicaid Paid
3,543
Total Claims
2,276
Beneficiaries
10
Codes Billed
2018-01
First Month
2021-08
Last Month

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 1,285 $19K
2019 1,345 $27K
2020 401 $5K
2021 512 $7K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0120 Periodic oral evaluation - established patient 381 381 $14K
D1110 Prophylaxis - adult 123 123 $8K
D0230 Intraoral - periapical each additional radiographic image 1,906 639 $8K
D0274 Bitewings - four radiographic images 386 386 $7K
D0150 Comprehensive oral evaluation - new or established patient 143 143 $7K
D1208 Topical application of fluoride, excluding varnish 459 459 $5K
D1120 Prophylaxis - child 104 104 $3K
D5750 15 15 $3K
D5751 14 14 $3K
D0220 Intraoral - periapical first radiographic image 12 12 $144.00